DESCRIPTION (adapted from the application) The candidate, Rulan Parekh, is on the faculty at Johns Hopkins University, in the Division of Nephrology, Departments of Pediatrics and Medicine. She is trained in both adult and pediatric nephrology and has obtained a Masters of Science in Biostatistics and Clinical Research Design at the University of Michigan. Her goal is to become a clinician-scientist focused on cardiovascular disease and ESRD using the tools of epidemiology and biostatistics. To realize this goal, she has designed a program of course work that supplements previous training, and which includes structured mentoring by senior investigators, and the conduct of supervised, innovative research. Advanced Ph.D. level courses in genetic and cardiovascular epidemiology, among other topics will be taken. The structured mentoring will take place within the Welch Center for Prevention, Epidemiology, and Clinical Research. This center bridges the Schools of Public Health and Medicine and is a very rich research and mentoring environment. The research training vehicle proposed includes: 1) describing patterns of ASCVD risk factors in young adults with ESRD from the United States Renal Data Systems (USRDS) database; 2) an analyses of the incidence of ASCVD in young adults and its associated risk factors in the USRDS during five-years of follow-up; 3) a case-control study to compare the prevalence of sub-clinical ASCVD in 125 young adults ages 18-35 with ESRD treated in the Johns Hopkins/Gambro Outpatient Dialysis Units compared to 125 age matched type I DM controls treated in the Johns Hopkins Outpatient Center. The prevalence of sub-clinical atherosclerotic cardiovascular disease will be measured by two innovative non-invasive approaches of Doppler sonography of the carotid vessels to assess carotid intimal medial wall thickness, and ECG-triggered helical CT of the coronary vessels to assess coronary calcification. The prevalence of sub-clinical ASCVD will be determined, and correlated with traditional and novel ASCVD risk factors; and 4) a prospective three-year follow-up of the 125 ESRD cases above to quantify the progression of sub-clinical ASCVD and its predictors. This application has been thoroughly revised in response to the previous review. The proposed study of observational research will fill a major gap in our understanding of cardiovascular disease of young adults in this high-risk ESRD population. The incidence of ASCVD and the prevalence of modifiable and unmodifiable ASCVD risk factors will aid in the development of risk stratification for young adults with ESRD. The information generated from this work is essential to design clinical trials to prevent ASCVD in young adults with ESRD. The career development plan and research project described in this application will build a foundation for a successful career as an independent investigator.